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Correlation of histopathology of trabecular meshwork with clinical features in primary congenital glaucoma
  1. Rinky Agarwal1,
  2. Seema Sen2,
  3. Seema Kashyap2,
  4. Tanuj Dada1,
  5. Tapas Chandra Nag3,
  6. Viney Gupta1,
  7. Ramanjit Sihota1
  1. 1 Glaucoma research facility and services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Ocular Pathology, Glaucoma Research Facility and Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
  3. 3 Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Ramanjit Sihota, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; rjsihota{at}gmail.com

Abstract

Purpose To correlate histopathological changes of trabecular meshwork (TM) with clinical features in primary congenital glaucoma (PCG).

Methods This was a prospective interventional study including 66 eyes of 39 PCG children aged ≤12 months at diagnosis. Corneal clarity, corneal diameter (CD), intraocular pressure (IOP) and cup disc ratio (C:D ratio) were assessed at baseline and at 1-year follow-up. The trabecular meshwork (TM) specimens obtained during primary combined trabeculectomy and trabeculotomy augmented with Mitomycin-C were evaluated on light microscopy to look for eosinophilic membrane (EM), status of trabecular beams and trabecular endothelial cells (TEC), presence of intervening spaces, TM thickness and TEC count which were then correlated with clinical features.

Results At 1-year follow-up, IOP reduced from 27.96±10.2 to 11.88±5.63 mm Hg, p<0.001, C:D ratio decreased from 0.65±0.34 to 0.49±0.06, p=0.036, and the bleb had a significant tendency to change from well formed (59–46) to flat type (3–6) or thin, cystic type (4–14) (p=0.014). Presence of EM on the cameral surface was associated with a lower baseline IOP. Fused trabecular beams were associated with higher baseline IOP. The TM was significantly thicker in eyes with IOP >20 mm Hg at presentation (1.86±0.7 mm vs 1.3±0.47 mm, p=0.0356). Eyes with IOP ≤14 mm Hg at final follow-up had lower TEC count than eyes with IOP >14 mm Hg (0.92±0.45 cells/mm2 vs 1.00±0.74 cells/mm2, p=0.0028).

Conclusion A light microscopic analysis of surgical specimens may guide prognosis of PCG. However, larger studies are required to validate these results.

  • Anterior chamber
  • Glaucoma
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Footnotes

  • Contributors RA: patient care, manuscript preparation, statistical analysis; SS, SK, TCN: histopathological evaluation; TD, VG: manuscript review; ; RS: patient care, manuscript review, editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article.

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